1/ I usually avoid directly responding to individual examples of misinformation. I find it to be too tiring and most importantly I am reminded of the Twain quote: “Don’t argue with a fool, onlookers may not be able to tell the difference.”
2/ But I do feel the need to highlight one foolish statement by an infamous “MD Senator”. (news.yahoo.com/rand-paul-clai…)

I will just remind everyone of my posts about ivermectin in which I tried to present a balanced approach to the data.
3/ To repeat: Ivermectin is an antiparasitic drug that was originally used to clear mice, cattle, and other animals from worms. It really is an amazing drug that was then utilized in humans for all sorts of bad parasites that are everywhere in the world.
4/ As a direct quote from this review article (ncbi.nlm.nih.gov/pmc/articles/P…): “Ivermectin's impacts in controlling diseases which blighted the lives of billions of the poor and disadvantaged throughout the tropics, is why its discoverers were awarded the Nobel Prize in Medicine…
5/ …in 2015 and the reason for its inclusion on the World Health Organization's (WHO) “List of Essential Medicines.”

So why use it for COVID? There have been several studies looking at its antiviral properties, specifically in RNA viruses…coronaviruses.
6/ There have been numerous studies and reports over the past 18 months looking at its impact on this pandemic. In addition to the link above, here are another two metanalysis of all these studies. (journals.lww.com/americantherap… )
7/ To directly address the notion that there is some conspiracy about studying this drug in this setting, I refer you to this review of ALL the studies.
(cochranelibrary.com/cdsr/doi/10.10…) Please realize that there is no conspiracy theory about this drug.
8/ Look at this last link and see that the PDF copy of the analysis is 159 pages long. There is nothing hidden. There are a lot of headlines and tons of comparisons to hydroxychloroquine. Stop that. Look at the data if you are interested. You know what it will show?
9/ We still have no idea if it really works. Maybe it does. Maybe it doesn’t. Maybe it works in only certain populations. There is enough evidence to be intellectually honest and say there might be something there.
10/ However, there is also enough evidence to be intellectually honest and say it is no way a home run that wipes COVID off the earth.
11/ 1. The data specifically in patients receiving ivermectin after exposure looking at whether it prevents progression to admission to the hospital is very sloppy.
12/ However, reading through those studies, it yields a percentage range from 10% all the way up to an 85% success rate in keeping people out of the hospital (again, very, very sloppy data).
13/ There is only one study that hits the 85% range; all the others are in the mid to lower range. Please read these attached links and look to see just how biased, poorly run, poorly published, and unclear even the best studies are with the drug.
14/ Yet, let’s go with the highest number and assume for this discussion that there is an 85% reduction.

You know what has a >90% to 95% protection…vaccines!

2. Ivermectin is safe when utilized correctly. However, it can cause significant liver damage.
15/ It has only one human approval, but dozens of approvals for horses, cattle, dogs, and other animals. That one human approval is for intestinal parasites.
16/ The number of human patients reported and studied who have used ivermectin for COVID numbers in the less than 10000…anywhere. It is nowhere near an FDA approval process.
17/ You know what has now been delivered and constantly studied in over 250 million people…mRNA vaccines.

3. To address the use of this drug in children. Please realize that there are exactly 5 peer-reviewed reports of ivermectin use for COVID in children.
18/ Yes, there are dozens using this drug in other infections in children, but there are less than 20 children who have been studied and reported on in scientific studies in the world using ivermectin in COVID infections.
19/ You know how many children between the ages of 12 and 18 years have received at least one dose of a vaccine? About 11.8 million!

I like data sets with more zeros.

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More from @ChecchiaPaul

4 Jan
1/34 I think we need to develop new DSM-5 diagnoses: PPSD or Post Pandemic Stress Disorder. It’s related to PTSD. We all have it. We are seeing it everywhere. However, I think it is worth a bit of analysis and hopefully, some, re-calibrating in the face of Omicron.
2/34 First, by definition, here is a link to the criteria required to diagnose PTSD. (brainline.org/article/dsm-5-…) It’s worth clicking on this and reading through all of it.
3/34 While it seems clear that many of them apply to everyone right now, it is important to note the primary criteria.
Read 34 tweets
1 Jan
1/48 Well, I’m back to writing about COVID. Long 🧵 As I stated in previous posts on COVID, writing is a form of self-therapy as I work through my anxieties, frustrations, anger, disappointment, and ignorance.
2/48 I took the past couple of months off of social media because the need for therapy was greater when I was on social media than when I was off.
3/48 However, as I see the media stoking the fires of coronanxiety and COVID click bait; I found that I was writing a narrative in my head for self-care. Thus, I thought I would share my ideas.
Read 48 tweets
17 Oct 21
1/ Things are better as we wait for our smell and taste to return to normal. Apparently, my post about coming down with a couple of breakthrough cases was taken by many as a rallying cry that vaccines don’t work. Of course, my view is the opposite; but I do realize my bias.
2/ I live my professional life looking at the worst-case scenario, hoping to predict the decline in physiology early enough to intervene.
3/ I don’t know how often it occurs amongst healthcare workers, but the prevalence of the fear of uncontrollable illness blossoming from seemingly innocuous starts is high within those that work in critical care.
Read 16 tweets
6 Oct 21
"To conquer fear is the beginning of wisdom.”
— Bertrand Russell
Fear is not a motivational strategy for vaccine uptake; data and knowledge are far better. Here is just a little mid-week positive energy for those already vaccinated (with 2 doses)
and a bit of motivation for those still sitting on the fence. The source of data is from Ontario, Canada. (covid19-sciencetable.ca/ontario-dashbo…) This isn't about masking, ventilation, waning antibody levels, or hygiene theater; this is vaccination at work.
Just look at these attached pictures and realize that if you have made the right decision to vaccinate yourself and your family, you are safe. ImageImage
Read 4 tweets
26 Sep 21
1/ Reflection, introspection, and frustration. I don’t know if anyone else has had enough, but I know I have. I’m done. I’m done with doom scrolling about COVID. I’m done with falling into the fear cycle which dictates that enough is never enough; the “what about?”-isms.
2/ (Boosters for the elderly and highest risk…but what about completely healthy 30 year olds. Vaccinations for 5-year-olds…but what about infants?) I’m done with unvaccinated adults dictating the path of this infection for children.
3/ I’m done pretending that the CDC didn’t make an enormous mistake in utilizing poor data to formulate the message that those that are vaccinated are just as responsible for spread as the unvaccinated.
Read 54 tweets
13 Aug 21
1/ Quick update and then a few points to clarify:
Update: RSV has started to turn the corner. Hospitalizations are starting to come down. Unfortunately, COVID is now replacing them, but at least one is running its expected course.
2/ Some small positive news to report. (dshs.texas.gov/.../2020-21-RS…...)
Points to make:
1. Boosters are not failures and therefore should not be feared.
2. Vaccines are not antibiotics, vitamins, or therapies.
3. Our immune system is incredible.
3/ Lots of stuff, so I’m going to try to tackle them with data.
Will we all need a booster? No idea. I will start this post with a very clear caveat that I am not an ID physician, nor am I a vaccine virologist, immunologist, or molecular biologist.
Read 49 tweets

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